Senior HealthCare Payor BA — Remote

Wellframe; United States; Remote; USD 120,000 - 140,000; Full time

Job summary

UST HealthProof is seeking a Sr. Business Analyst to join the HealthPlan core admin team in a remote US role.

You will gather business and functional requirements across Claims, Enrollment, Provider and Payment systems, working with customers, vendors, and product teams. You will translate business needs into technical specs, map EDI transactions, and collaborate across onshore/offshore teams in an agile-like approach.

Qualifications

• Experience in healthcare payor domains including Claims, Enrollment, Provider, Payment.
• Excellent requirement elicitation and communication skills for agile environments.
• Experience mapping healthcare EDI transactions (837, 834, 835, 270/271, 276/277, 278).
• Experience with onshore/offshore delivery models.

Responsibilities

• Lead business requirement conversations with customer and internal teams.
• Develop business and functional requirements for Claims, Enrollment, Provider, Authorization, Payment systems.
• Create solutions for current processes using core-admin ecosystem.
• Collaborate with IT, business users, and offshore staff to ensure the product meets objectives.
• Participate in sprint planning, retrospectives, and go-live decisions.
• Conduct MVP demos for the customer.

Skills

Healthcare domain knowledge

EDI mapping

Agile methodologies

Stakeholder communication

Onshore/offshore collaboration

Education

Bachelor’s degree or higher in business or technical field

Tools

HealthEdge HealthRules Payor

GuidingCare

SQL

XSD

Job description

UST HealthProof is seeking a Sr. Business Analyst to join the HealthPlan core admin team in a remote US role.

You will gather business and functional requirements across Claims, Enrollment, Provider and Payment systems, working with customers, vendors, and product teams. You will translate business needs into technical specs, map EDI transactions, and collaborate across onshore/offshore teams in an agile-like approach.